Primary Health Care Interventions Research Articles

Enhanced Primary Health Care Intervention: Perceived Sustainability and Challenges Among Implementers.

Purpose:This study aimed to assess and explore perceived sustainability and challenges of the intervention among Health Care Providers (HCPs) who were involved.Methods:The study applied mixed-method embedded design to analyze both quantitative and qualitative data. Quantitative approach was used to evaluate sustainability perception from 20 intervention clinics via self-reported assessment form whereas qualitative data were obtained through in-depth interview (IDI) and focus group discussions (FGDs) 14 health care professionals participated in IDI session and were either care coordinators, liaison officers (LOs)/clinic managers, or medical officers-in-charge for the clinic’s intervention. Nine FGDs conducted comprised 58 HCPs from various categories.Results:HCPs from all the 20 clinics involved responded to each listed Enhanced Primary Healthcare (EnPHC) intervention components as being implemented but the perceived sustainability of these implementation varies between them. Quantitative feedback showed sustainable interventions included risk stratification, non-communicable disease (NCD) screening form, referral within clinics and hospitals, family health team (FHT), MTAC services and mechanisms and medical adherence status. Qualitative feedback highlighted implementation of each intervention components comes with its challenges, and most of it are related to inadequate resources and facilities in clinic. HCPs made initiatives to adapt based on clinical setting to implement the interventions at best level possible, whereby this seems to be one of the core values for sustainability.Conclusion:Overall perceptions among HCPs on sustainability of EnPHC interventions are highly influenced by current experiences with existing resources. Components perceived to have inadequate resources are seen as a challenge to sustain. It’s crucial for stakeholders to understand implications affecting implementation process if concerns raised are not addressed and allocation of needed resources to ensure overall successfulness and long term sustainability.

Community management of substance use disorders: Past, present, and future

Substance use disorder (SUD) is a common entity in the Indian population, with a huge treatment gap of around 90%. Poor availability, accessibility and acceptability due to various reasons contribute to the treatment gap. The management of SUD at the community level can reduce this gap. Various private, government, and nongovernmental organizations (NGOs) are the leading agencies to provide pharmacological and nonpharmacological treatment at the community level in India. Historically, addiction treatment “camps” were efficient, cost-effective, and resource-saving community treatment approaches. Conventionally, there has been an attempt to integrate SUD treatment in primary healthcare, but this requires training and resource development at the community level. Outreach clinics, organized by tertiary care hospitals, help in training and research, besides catering to the community need for treatment. NGOs also help in the provision of treatment, awareness generation and capacity building at the community level. Currently, integration of screening and brief intervention with primary care is being tried in various community setups. This approach would be more effective with an efficient referral system. Telemedicine emerged as a new tool during the Coronavirus disease-19 pandemic. Telemedicine has been efficiently incorporated in the hub and spoke model and has been found to enhance the community treatment of difficult to reach patients with SUD. Various modifications in telemedicine help in more efficient diagnosis, decision-making, and treatment. Proper integration of multiple approaches can help in effective service delivery in a resource-limited setup in the community.

Suicide After and During the COVID-19 Pandemic in Mexico City

Background: A first report on the short-term effects of COVID-19 pandemic on death by suicide, that included data from Mexico City, suggested that no increase in suicide was apparent immediately following the declaration of emergency. We followed up this initial analysis by adding longer-term suicide trends from Mexico City and by inspecting basic demographic groups. Methods: We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from Jan 1, 2010, to March 31, 2020), comparing the expected number of suicides derived from the model with the observed number of suicides in the following months of the pandemic (from April 1 to November 30, 2020). Findings: The number of monthly suicides changed from 30·2 to 30·9. There was an increase in suicide during the first 8 months of the pandemic, with a RR of 1·74 (1·37-2·20). Most of the increase occurred beyond June 2020, when there was an increase of about 70% that was then maintained. The increase was mostly accounted for by male residents of Mexico City, regardless of their age 1·95 (1·51-2·52). Overall, there was no change in the number of female suicides but those in the older age group should be closely monitored (RR=2·00; 0·96-3·68). Interpretation: The increase in suicides by male residents of Mexico City is worrying and reinforces the need to strengthen actions for economic development, mental health and wellbeing. As the city is widening primary health care services and interventions there is an opportunity to include suicide prevention and treatment.Funding Information: No funding was used for this manuscript.Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: The Ethical Committee of the National Institute of Psychiatry cleared this work for ethical approval.

A comprehensive approach to health promotion for the reduction of dental caries in remote Indigenous Australian children: A clustered randomised controlled trial

To evaluate the effect of a community-oriented primary health care (CPHC) intervention on oral health behaviours of Indigenous preschool children living in remote communities of Australia's Northern Territory. The study was a community-clustered randomised controlled trial over two years, set in 30 remote Indigenous communities in the Northern Territory of Australia. Children aged 18-47 months at baseline were enrolled in the study. The intervention included fluoride varnish applications, training of primary care workers, and health promotion for oral health at an individual, family and community level. Intervention communities received six-monthly visits over two years and control communities were visited at baseline and two years later with no contact in the intervening period. The outcome measures reported in this paper are the impact of the intervention on two secondary endpoints: oral health promotion activities in the community and personal oral health practice of children. The intervention did not produce any significant change in oral health behaviours, clinical measures of oral hygiene, or community programmes promoting oral health. Dental caries can be reduced but will continue to be a problem among young remote Indigenous children while they experience major social disadvantage.

Community health workers in humanitarian settings: Scoping review.

BackgroundThere is a need for greater understanding of experiences implementing community-based primary health care in humanitarian settings and of the adjustments needed to ensure continuation of essential services and utilization of services by the population, and to contribute to effective emergency response. We reviewed the evidence base on community health workers (CHWs) in humanitarian settings, with the goal of improving delivery of essential services to the most vulnerable populations.MethodsWe conducted a scoping review of published and grey literature related to health and nutrition services provided by CHWs in humanitarian settings. Extracted data from retained documents were analyzed inductively for key themes.ResultsOf 3709 documents screened, 219 were included in the review. Key findings from the literature include: 1) CHWs were often able to continue providing services during acute and protracted crises, including prolonged periods of conflict and insecurity and during population displacement. 2) CHWs carried out critical emergency response activities during acute crises. 3) Flexible funding facilitated transitions between development and humanitarian programming. 4) Communities that did not have a locally-resident CHW experienced reduced access to services when travel was limited. 5) Community selection of CHWs and engagement of respected local leaders were crucial for community trust and acceptance and high utilization of services. 6) Selection of local supervisors and use of mobile phones facilitated continued supervision. 7) Actions taken to maintain supplies included creating parallel supply chains, providing buffer stocks to CHWs, and storing commodities in decentralized locations. 8) When travel was restricted, reporting and data collection were continued using mobile phones and use of local data collectors. 9) CHWs and supervisors faced security threats and psychological trauma as a result of their work.ConclusionsTo achieve impact, policy makers and program implementers will have to address the bottlenecks to CHW service delivery common in stable low-income settings as well as the additional challenges unique to humanitarian settings. Future interventions should take into account the lessons learned from years of experience with implementation of community-based primary health care in humanitarian settings. There is also a need for rigorous assessments of community-based primary health care interventions in humanitarian settings.

Effect of implementation intention on walking in people with diabetes: an experimental approach.

ABSTRACTOBJECTIVETo evaluate the effect of implementation intentions as an intervention strategy to promote walking in adults with type 2 diabetes mellitus (T2DM).METHODSWe conducted a controlled and randomized trial, with 12 months of follow-up, involving 65 people with T2DM recruited from primary health care units and allocated them in the control group (CG, n = 32) and intervention group (IG, n = 33). The IG received the implementation intention strategy to promote walking and the CG remained in follow-up for conventional treatment in primary health care. The researchers were blinded by anthropometric measurements and the filling of the instruments.RESULTSAfter twelve months of follow up, the IG presented a statistically significant increase in the leisure time physical activity when compared with the CG (p = 0.0413) and showed a significant decrease in waist circumference (p = 0.0061). No significant difference was observed regarding body mass index and glycated hemoglobin among groups.CONCLUSIONSImplementation intention was effective in promoting walking and improving clinical indicators in adults with T2DM.

Intermediate weight changes and follow-up of dietetic treatment in primary health care: an observational study

BackgroundPrimary health care data have shown that most patients who were treated for overweight or obesity by a dietitian did not accomplish the recommended treatment period. It is hypothesised that a slow rate of weight loss might discourage patients from continuing dietetic treatment. This study evaluated intermediate weight changes during regular dietetic treatment in Dutch primary health care, and examined whether weight losses at previous consultations were associated with attendance at follow-up consultations.MethodsThis observational study was based on real life practice data of overweight and obese patients during the period 2013–2017, derived from Dutch dietetic practices that participated in the Nivel Primary Care Database. Multilevel regression analyses were conducted to estimate the mean changes in body mass index (BMI) during six consecutive consultations and to calculate odds ratios for the association of weight change at previous consultations with attendance at follow-up consultations.ResultsThe total study population consisted of 25,588 overweight or obese patients, with a mean initial BMI of 32.7 kg/m2. The BMI decreased between consecutive consultations, with the highest weight losses between the first and second consultation. After six consultations, a mean weight loss of − 1.5 kg/m2 was estimated. Patients who lost weight between the two previous consultations were more likely to attend the next consultation than patients who did not lose weight or gained weight.ConclusionsBody mass index decreased during consecutive consultations, and intermediate weight losses were associated with a higher attendance at follow-up consultations during dietetic treatment in overweight patients. Dietitians should therefore focus on discussing intermediate weight loss expectations with their patients.

Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa

Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs’ confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.

Risk assessment for oral urgent treatment in Primary Healthcare: a cross-sectional study

BackgroundThe World Health Organization has advocated for the integration of dental care into the primary healthcare (PHC) setting, including oral urgent treatment (OUT). However, the knowledge necessary for OUT implementation in this setting is still limited. Thus, this study aimed to describe the impact of the implementation of oral disease risk assessment tools for oral health management in PHC.MethodsThis was a cross-sectional study that included individuals served by a single public PHC unit, with integrated oral healthcare teams, located in the south region of the city of São Paulo, Brazil, between April of 2015 and March of 2017. Data were collected from dental records. Three co-primary endpoints: same day treatment offered, first future appointment scheduled fulfilled, and treatment plan completed were compared before and after the implementation of oral disease risk assessment for OUT.ResultsA total of 1214 individuals that sought OUT, 599 before and 615 after the implementation of oral disease risk assessment for OUT were included in the study. All three co-primary endpoints had significant changes after the implementation of oral disease risk assessment for OUT. Individuals were significantly more likely to be offered same day treatment after (39.9%; 95% CI:36.0–43.9%) than before (9.4%; 95% CI: 7.2–12.0%), to fulfill their first future appointment scheduled after (34.9%; 95% CI:31.1–38.8%) than before (20.7%; 95% CI: 17.5–24.2%), and to have their treatment plan completed after (14.3%; 95% CI:11.6–17.4%) than before (10.0%; 95% CI: 7.7–12.7%) the intervention.ConclusionsThis study provided evidence of the positive impact oral disease risk assessment tools could have in the organization of OUT in PHC settings.

Anxiety, depression and post-traumatic stress disorder management after critical illness: a UK multi-centre prospective cohort study

BackgroundSurvivors of critical illness have significant psychopathological comorbidity. The treatments offered by primary health care professionals to affected patients are unstudied.AimTo report the psychological interventions after GPs received notification of patients who showed severe symptoms of anxiety, depression or Post-Traumatic Stress Disorder.MethodsDesign: Multi-centre prospective cohort sub-study of the ICON study. Setting: NHS primary care in the United Kingdom. Participants: Adult patients, November 2006–October 2010 who had received at least 24 h of intensive care, where the general practitioner recorded notification that the patient had reported severe symptoms or caseness using the Hospital Anxiety and Depression Scale (HADS) or the Post-Traumatic Stress Disorder Check List-Civilian (PCL-C). Interventions: We notified general practitioners (GPs) by post if a patient reported severe symptoms or caseness and sent a postal questionnaire to determine interventions after notification. Main outcome measure: Primary or secondary healthcare interventions instigated by general practitioners following notification of a patient’s caseness.ResultsOf the 11,726 patients, sent questionnaire packs containing HADS and PCL-C, 4361 (37%) responded. A notification of severe symptoms was sent to their GP in 25% (1112) of cases. Of notified GPs, 65% (725) responded to our postal questionnaire. Of these 37% (266) had no record of receipt of the original notification. Of the 459 patients where GPs had record of notification (the study group for this analysis), 21% (98) had pre-existing psychopathology. Of those without a pre-existing diagnosis 45% (162) received further psychological assessment or treatment. GP screening or follow-up alone occurred in 18% (64) whilst 27% (98) were referred to mental health services or received drug therapy following notification.ConclusionsPostal questionnaire identifies a burden of psychopathology in survivors of critical illness that have otherwise gone undiagnosed following discharge from an intensive care unit (ICU). After being alerted to the presence of psychological symptoms, GPs instigate treatment in 27% and augmented surveillance in 18% of cases.Trial registrationISRCTN69112866 (assigned 02/05/2006).

An Assessment of the Implementation Impact of SURE-P Intervention on Maternal Mortality in the Selected Local Governments in Niger State, Nigeria

The objective of this study was to explore the implementation of the SURE-P intervention on primary healthcare among the selected local government areas of Niger State, Nigeria. In these local governments, the primary health centers are not enough, and the existing ones are dilapidated with the absence of facilities needed to operate effectively. To access medical services, some communities must travel long distances, resulting in high mortality rates. This study examined the perceptions of Desk Officers regarding implementing the SURE-P intervention in primary healthcare among the selected local government. A descriptive design within the qualitative tradition was used in the Study. Thirteen SURE-P desk officers from the state and selected local governments were purposively selected as participants for this study. Semi-structured interviews were used to collect data, and a thematic framework was used for interpretation. The results revealed that the primary healthcare SURE-P initiative had improved access to medical facilities across the selected local governments, resulting in a slide reduction in maternal motility. Furthermore, there was a lack of adequate assessment of needs, insufficient funding, relatively low inclusion, and political pressure in the implementation process. Based on findings, it is recommended that the SURE-P intervention be sustained, adequately financed, that the community members' priority needs should be addressed, that the community members should be more inclusive, and track the implementation of the SURE-P intervention.

Comparing Mindful and Non-Mindful Exercises on Alleviating Anxiety Symptoms: A Systematic Review and Meta-Analysis.

Background: In recent years, studies and reviews have reported the therapeutic benefits of both mindful and non-mindful exercises in reducing anxiety. However, there have not been any systematic reviews to compare their relative effectiveness for therapeutic application, especially among the non-clinical population. Thus, the aim of this review is to compare the effectiveness between mindful and non-mindful exercise on treating anxiety among non-clinical samples. Methods: Potential articles were retrieved from PubMed, Embase, Academic Search Premier, and PsycInfo. Randomized controlled trials, which involved both mindful and non-mindful exercises as intervention, and the use of anxiety outcome measures were included. Results: Twenty-four studies fulfilled the inclusion criteria and were included in our systematic review. In addition, 14 studies provided sufficient data to be included in the meta-analysis. For studies that reported significant group differences at post-assessment, results showed that mindful exercise was more beneficial in reducing anxiety than non-mindful exercise. The meta-analysis reported that yoga was more effective in reducing anxiety than non-mindful exercise. Conclusions: Compared to non-mindful exercise, yoga is shown to be more effective in alleviating anxiety symptoms. It is recommended that yoga could be used as a primary healthcare intervention to help the public reduce anxiety.

A Comparison of the Socio-Behavioral-Metabolic Risk Profiles and Associated Factors for Chronic Diseases of Lifestyle in Urban and Rural Communities in Central South Africa.

Background: The global escalating prevalence of lifestyle-related non-communicable diseases places a significant burden on health systems. Chronic diseases of lifestyle (CDL) are a group of diseases that share similar modifiable risk factors that can result in long-term disease processes. Considering the socio-behavioral-metabolic risk profiles of communities and risk factors predictive of the presence of CDL can assist in the development of focused and effective community-based prevention, intervention, and treatment programs for CDL.Aim: To determine the socio-behavioral-metabolic risk profiles and identify associated factors for the following CDL: obesity, cardiovascular disease, hypertension, and type 2 diabetes mellitus in rural and urban communities in central South Africa.Methodology: This cross-sectional study included adults aged 25–65 years in the rural Southern Free State and urban Mangaung. Social determinants, behavioral and metabolic risk factors, and inflammatory biomarkers for CDL were determined.Results: In total, 575 rural (mean age: 42 years; 71% female) and 429 urban (mean age: 44 years; 76% female) participants were included in the study. More than 20% of participants in both communities reported being previously diagnosed with cardiovascular diseases; with reported hypertension and diabetes mellitus more prevalent among rural participants. Insufficient intake of fruit and vegetables, alcohol use, and high blood pressure were among the top five risk factors in both communities. Physical inactivity ranked among the top two risk factors in the urban community; while alcohol and tobacco use was significantly higher in the rural community. Fibrinogen was the most prevalent inflammatory marker in both communities (32.9 rural vs. 48.3% urban). High sensitivity C-reactive protein (Hs-CRP), only available for rural participants, was high with increased levels in more than 80% of participants. In both communities, being female, having high blood pressure and increased fibrinogen levels were associated with obesity.Conclusion: This study illustrated the high prevalence of socio-behavioral-metabolic risk factors for CDL, and identified similarities and distinct differences in the risk profiles of rural and urban communities. Considering the CDL risk profiles of communities can assist in prioritizing health needs and contribute to the development of tailor-made community-based primary health care prevention, intervention, and health promotion programs.

Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review.

Polypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review. This scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW). A scoping review was conducted that involved searches of six databases (2002-2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT). Searches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion. Deprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.

Can patients make heads or tails of enhanced primary health care (EnPHC)? Experience through their own journey

BackgroundImplementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients’ experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients.MethodsThis phenomenological qualitative study focussed on patients’ experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach.ResultsA total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient’s health through their lens.ConclusionEven though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.

The Need for Adolescent Mental Health Intervention in Primary Health Care

Mental health problems in adolescents became a global concern. About 10–20% of children and adolescents worldwide experience mental health problems, but only about 10% get medical attention. This study aims to perform an initial screening of adolescent mental health in Bandung, especially adolescents at school age, to get the magnitude of the problem of mental health in adolescents. This research was a cross-sectional study conducted in Bandung. Data collected in December 2018. The study used consecutive sampling to recruit 140 students from junior and senior high schools. The instrument used was the strength and difficulties questionnaire (SDQ) YR1 version, which was filled independently by respondents. Data were analyzed using STATA 13. The results of this study were that the prevalence of mental health problems in adolescents was 21%. The highest aspect was emotional (28%) and conducted problems (21%). There was a significant different male versus female in emotional and conduction problems. In conclusion, the magnitude of the adolescent's mental health problems in Bandung was enormous; thus, interventions at the primary care level and partnership with another sector needed. PERLUNYA INTERVENSI KESEHATAN MENTAL REMAJA DI PELAYANAN KESEHATAN PRIMERMasalah kesehatan mental pada remaja telah menjadi perhatian dunia. Sekitar 10–20% anak dan remaja di seluruh dunia mengalami masalah kesehatan mental, tetapi hanya 10% yang mendapatkan pelayanan kesehatan. Tujuan penelitian ini melakukan penapisan awal besaran masalah kesehatan mental pada remaja usia sekolah di Kabupaten Bandung. Penelitian ini merupakan penelitian potong lintang yang dilakukan di Kabupaten Bandung. Data dikumpulkan pada bulan Desember 2018 menggunakan consecutive sampling dengan melibatkan 140 siswa SMP dan SMA. Instrumen yang digunakan adalah strength and difficulties questionaire (SDQ) YR1 version yang diisi oleh responden. Data dianalisis menggunakan STATA 13. Hasil penelitian didapatkan prevalensi masalah kesehatan mental pada remaja adalah 21%. Aspek penilaian tertinggi berada pada masalah emosional (28%) dan conducting problem (21%). Terdapat perbedaan nilai yang siginifikan untuk aspek emosinal dan conduct problem antara kelompok laki-laki dan perempuan. Simpulan, masalah kesehatan mental remaja di Kabupaten Bandung sangat besar sehingga dibutuhkan penanganan kesehatan mental remaja di tingkat pelayanan kesehatan primer dan kerja sama dengan sektor lain.

The CanMoRe trial \u2013 evaluating the effects of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer: the study protocol of a randomised controlled trial

BackgroundPatients who have undergone radical cystectomy for urinary bladder cancer are not sufficiently physically active and therefore may suffer complications leading to readmissions. A physical rehabilitation programme early postoperatively might prevent or at least alleviate these potential complications and improve physical function. The main aim of the CanMoRe trial is to evaluate the impact of a standardised and individually adapted exercise intervention in primary health care to improve physical function (primary outcome) and habitual physical activity, health-related quality of life, fatigue, psychological wellbeing and readmissions due to complications in patients undergoing robotic-assisted radical cystectomy for urinary bladder cancer.MethodsIn total, 120 patients will be included and assigned to either intervention or control arm of the study. All patients will receive preoperative information on the importance of early mobilisation and during the hospital stay they will follow a standard protocol for enhanced mobilisation. The intervention group will be given a referral to a physiotherapist in primary health care close to their home. Within the third week after discharge, the intervention group will begin 12 weeks of biweekly exercise. The exercise programme includes aerobic and strengthening exercises. The control group will receive oral and written information about a home-based exercise programme.Physical function will serve as the primary outcome and will be measured using the Six-minute walk test. Secondary outcomes are gait speed, handgrip strength, leg strength, habitual physical activity, health-related quality of life, fatigue, psychological wellbeing and readmissions due to complications. The measurements will be conducted at discharge (i.e. baseline), post-intervention and 1 year after surgery. To evaluate the effects of the intervention mixed or linear regression models according to the intention to treat procedure will be used.DiscussionThis proposed randomised controlled trial has the potential to provide new knowledge within rehabilitation after radical cystectomy for urinary bladder cancer. The programme should be easy to apply to other patient groups undergoing abdominal surgery for cancer and has the potential to change the health care chain for these patients.Trial registrationClinicalTrials.gov. Clinical trial registration number NCT03998579. First posted June 26, 2019.

Transnationalism and care of migrant families during pregnancy, postpartum and early-childhood: an integrative review

BackgroundMigrant families’ transnational ties (i.e., connections to their countries of origin) may contribute to their hardships and/or may be a source of resiliency. A care approach that addresses these transnational ties may foster a positive identity and give coherence to experiences. We conducted an integrative review to determine what is known about transnational ties and the care of migrant families during pregnancy, postpartum and early childhood.MethodsWe searched 15 databases to identify literature reporting on a health or social program, service, or care experience of migrant families during pregnancy up to age five in a Western country (i.e., Canada, US, Australia, New Zealand or a European country). Information regarding if and how the service/program/care considered transnational ties, and care-providers’ perceptions of transnational ties, was extracted, analyzed and synthesized according to transnational ‘ways of belonging’ and ‘ways of being’.ResultsOver 34,000 records were screened; 69 articles were included. Care, programs and services examined included prenatal interventions (a mhealth app, courses, videos, and specialized antenatal care), doula support, maternity care, support groups, primary healthcare and psycho-social early intervention and early childhood programs. The results show that transnational ties in terms of ‘ways of belonging’ (cultural, religious and linguistic identity) are acknowledged and addressed in care, although important gaps remain. Regarding ‘ways of being’, including emotional, social, and economic ties with children and other family members, receipt of advice and support from family, and use of health services abroad, there is very little evidence that these are acknowledged and addressed by care-providers. Perceptions of ‘ways of belonging’ appear to be mixed, with some care-providers being open to and willing to adapt care to accommodate religious, cultural and linguistic differences, while others are not. How care-providers perceive the social, emotional and economic ties and/or the use of services back home, remains relatively unknown.ConclusionSignificant knowledge gaps remain regarding care-providers’ perceptions of transnational ‘ways of being’ and whether and how they take them into account, which may affect their relationships with migrant families and/or the effectiveness of their interventions. Continued efforts are needed to ensure care is culturally safe for migrants.

Sleep timing and hygiene practices of high bedtime procrastinators: a direct observational study.

Bedtime procrastination (BP) has been proven to be an important indicator of sleep insufficiency from a psychological perspective. However, the effect of BP on sleep patterns related to sleep deficiency remains unknown. This study aimed to investigate the characteristics of self-reported sleep timing and hygiene practices between high and low-moderate bedtime procrastinators. It also aimed to examine the relationship between these characteristics and high level of BP. A total of 391 Chinese college students were recruited for this study. Participants completed questionnaires on demographics, sleep timing variables, the Sleep Hygiene Practice Scale (SHPS) and the Bedtime Procrastination Scale (BPS). High bedtime procrastinators were more likely to have higher SHPS global and subdomain scores (Ps < 0.001). They also were more likely to exhibit later sleep onset, sleep offset and rise time on both weekdays and weekends (Ps < 0.01). The significant independent determinant factors of the prevalence of high BP were: SHPS total score [odds ratio (OR) = 1.05, P < 0.001], arousal-related behaviour (OR = 1.07, P = 0.007), sleep schedule and timing (OR = 1.12, P < 0.001) and sleep onset on weekdays (OR = 2.65, P < 0.001). High bedtime procrastinators showed maladaptive sleep-related variables, which mainly manifested as changes in arousal-related behaviour and sleep schedule and timing, as well as delays in sleep onset time on weekdays. The findings could help guide the formulation of appropriate interventions in primary health care.

Manitoba First Nation peoples' use of hospital-based mental health services: trends and solutions.

The objective of this article is to document patterns and trends of in-hospital mental health service use by First Nations (FN) living in rural and remote communities in the province of Manitoba. Our sample included all Manitoba residents eligible under the Manitoba Health Services Insurance Plan living on FN reserves and those living in rural and remote communities from 1986 to 2014. Using administrative claims data, we developed multi-level models that describe hospitalization for mental health conditions shown responsive to primary healthcare interventions. We aggregated the results by First Nation Tribal Councils and remoteness to derive rates of hospitalization episodes, length of stay and readmission rates. Rates of hospitalization for mental health are increasing for FN males and females. This is particularly evident for those affiliated with the Island Lake and Keewatin Tribal Councils. The length of stay has increased. Changes in rates of readmissions were not statistically significant. FNs are admitted for mental health conditions at a younger age when compared with other Manitobans, and trends show that the FNs' average age at admission is decreasing. Our results raise serious concerns about the responsiveness of community-based mental health services for FNs in Manitoba, because of both increasing rates of episodes of hospitalization and decreasing age of admission. Given the documented lack of mental health services accessible on-reserve, levels of social distress associated with a history of oppressive policies, and continued lack of infrastructure, current trends are alarming.